It is reasonable to delay the antibiotic treatment of a few days in all the apparently not serious cases of upper respiratory infection. "Risk" groups, in which antibiotics should be used to treat each fever, are: chronic pulmonary, kidney and heart diseases, immunodeficiency, cystic fibrosis, muscular diseases and prematurity. In case of a child with sore throat, if there are other concomitant signs of respiratory infection (nasal secretion, cough) it is certainly a viral disease. If pharyngitis is not accompanied by signs of infection to the upper respiratory tract, perform rapid strep test, it should come out positive in half of cases. Antibiotics are of little help in sinusitis. If the cough that accompanies fever is very severe and the outcome of auscultation is not significant, respiratory rate must be counted. If it is not higher than 45/m (under 2 years) it is not bronchopneumonitis, or at least, the latter is neither significant nor worrying. Waiting is still reasonable. The problem of antibiotic resistance for excessive use is real; it certainly concerns more macrolides than amoxicillin and it is proportional to the antibiotic pressure (which is very high in Italy). The problem of methicillin-resistant Staphylococcus pathology, though quantitatively limited, is growing and may have tragic outcomes. The "complete" resistance of Pneumococcus to amoxicillin is assessed at about 2-3%. An intermediate resistance (between 10% and 15%) can be easily overcome by using, when needed, higher doses of amoxicillin.
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The hyperventilation psychogenic Crisis (HPC) can appear as a sensation of shortness of breath, chest pain, palpitations, dizziness, headaches, numbness in the hands, and sometimes as a tetanus like state. For their classification they are included in non-epileptic paroxysmal episodes (NEPE). The patient interview and the clinical examination are the clues for the diagnosis and they prevent from unnecessary treatment and additional studies. The aim of this paper is to present two patients who consulted for NEPE secondary to HPC.
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The debate about acute otitis media (AOM) is endless, like any other subject that greatly affects the daily routine of the family paediatrician. However, much greater rigour is needed in the use of antibiotics (to safeguard a heritage that is certainly not infinite), so our prescription habits must be reassessed. Therefore, the vigilant wait in AOM has become a possible tested and recommended behaviour that today guidelines have opportunely fixed. There are no longer excuses or justifications. However, it is true that otitis with severe otalgia (eversion of the tympanic membrane) must be opportunely and conveniently treated immediately upon the onset at all ages. A few days of therapy with high doses of amoxicillina three times a day is the best treatment. The association with clavulanic acid should mainly be administered to children under 2 years old.
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